Articles on Pharmacy Benefit Management

Tenn. Blues: 'Rx Repository, e-Prescribing May Curb Drug Use'

Reprinted from the February 2007 issue of The AIS Report on Blue Cross and Blue Shield Plans, a hard-hitting independent monthly newsletter on business strategies, products and markets, mergers and alliances, and financing of BC/BS plans.

BlueCross BlueShield of Tennessee is involved in several state initiatives — including the development of an electronic prescription repository and a program aimed at increasing e-prescribing — that it says could help bring the state's per-capita drug usage closer to that of the rest of the country.

Tennessee residents use more prescription drugs than do residents of any other state in the nation — an average of 17.3 prescriptions a year for each individual, compared with 11.3 prescriptions per individual nationwide, according to a report released Feb. 5 by the insurer. The 17-page report, based on data from 2005, was produced by the Tennessee Blues plan with oversight by the Tennessee Medical Association and the Tennessee Dept. of Health.

High prescription-drug use in Tennessee is a trend that goes back to 1997 — the year the state began tracking it. In 2005, according to Novartis AG, prescription drug spending in the state was $7 billion — about $1,192 per resident. While Tennessee continues to lead the nation in per-capita drug use, the annual average in 2005 was about one prescription per person lower than in 2004. Despite high drug usage, the state ranks 47th in terms of health status, the study found.

TennCare, the state's Medicaid program, is at least partially to blame for the high prescription drug use. Through that program, enrollees previously were not limited on the number of prescriptions they could have and were not required to spend any out-of-pocket money for them. TennCare enrollees had an average of more than 25 prescriptions per year per member. In 2005, the state placed a limit on the number of prescriptions allowed.

"If TennCare would have required a modest copayment [for prescription drugs], there is no question that would have made a difference," says Bill Cecil, health policy director at the Tennessee Blues plan. State lawmakers, he adds, were reluctant to create financial barriers for low-income enrollees. He predicts that limiting the number of prescriptions will lead to a "fairly significant" drop in prescriptions over the next year.

About 614,000 lives are covered through BlueCare/TennCare Select, but 290,000 will transition to a new MCO (AMERIGROUP Corp. and AmeriChoice) on April 1.

However, about 400 prescription drugs are not affected by the limits, notes TennCare spokesperson Marilyn Wilson. And beginning this month, enrollees or their doctors can urge the pharmacy benefit manager to make a one-time exception to the rule. "Someone with comorbidities might present with another condition and need an antibiotic just this one month," she explains.

Enrollees are now limited to five prescriptions per month, and just two can be for brand-name medications. The change, according to TennCare, caused generic drug use among enrollees to jump from 56% in 2005 to 71% in 2006.

Two of the most troubling issues for the state are high incidents of accidental drug-related poisonings and abuse, Cecil says. In Tennessee, between 1999 and 2003, the death rate caused by errors linked to prescription and over-the-counter drugs doubled from 4.17 deaths per 100,000 to 8.46, according to the Tennessee Blues report. This death rate is 26% higher than the national average.

"In a state of 5.8 million, 550 people died just from medication poisonings in 2003. That's an awful lot," Cecil tells The AIS Report. In 2003, adverse drug events cost the state $761 million, and accidental poisonings added another $593 million, the report says. The risk is highest for patients aged 65 or older, who are seven times more likely to suffer a drug-related error due to multiple prescriptions, according to a 2006 study from Medco Health Solutions, Inc.

Electronic Rx Repository Could Help

State officials are optimistic that the creation of an electronic repository of prescriptions will help reduce the rate of prescription errors by giving physicians a way to track their patients' prescriptions regardless of who prescribed them. "That will be a level of control that hasn't previously existed," Cecil says. Such an electronic clearinghouse also could help identify problematic prescriptions and those persons who fill multiple prescriptions at several pharmacies with the intent of selling them. The Tennessee Board of Pharmacy has launched the Tennessee Controlled Substance Database program, designed to provide doctors with data to help eliminate prescription abuse and to improve patient safety.

Increased use of e-prescribing also is expected to curb the abuse of [prescription] drugs. "One of the big issues is forgery of paper prescriptions," Cecil explains. "E-prescribing immediately eliminates the paper prescription as a source of the problem." It also will make it easier to create an electronic prescription repository in the state, he adds.

Through a pilot program sponsored by the U.S. Dept. of Health and Human Services, 50 rural doctors and pharmacists in the state will be part of a national pilot project to create an e-prescribing program that can be adapted to other state Medicaid programs. TennCare will receive $674,204 to be used for computers, training and software that helps doctors identify potential adverse drug interactions that patients might encounter. The Tennessee grant is part of $103 million being given to 27 state Medicaid programs.

Advertise With AIS

Privacy

Site Map